Factors to consider when choosing a healthcare plan


Choosing a healthcare plan is not something you wake up and decide on. It’s a confusing process that requires lots of research and comparing different insurance companies. You have to compare a wide array of plans, providers and coverage options, and that can be a challenge to navigate. You have to get a plan that resonates well with your goals.

Following are some factors that will help you choose the best health plan

The plan and providers

Before committing yourself to a particular plan, you have to ask yourself; do the hospitals and other medical facilities you prefer fall within the insurance company’s network? If the insurance you choose doesn’t have those hospitals covered, it could mean you go to other health facilities in their network, something that may not go well with you. That is why you must ensure the plan you go for covers your preferred hospitals. You’ll not have issues with out-of-pocket costs.


How much will you be required to pay for monthly premiums?

Premiums are the payments you make to the insurance company for coverage. The premiums are usually paid per month or quarterly, and if you miss payments or stop paying, you lose your coverage. You’ll also be required to pay for deductibles and cost-sharing.


How much money will you be required to pay out-of-the-pocket before the coverage kicks in? It’s the amount you pay toward an insured loss. When you get into a car accident or a disaster strikes at home, the deductible amount is subtracted/ deducted from the claim payment. Deductibles are the way risk is shared between the policyholder and the insurer. The larger the deductibles, the less the monthly premiums. A deductible can be a percentage of the total insurance policy amount or a specific dollar amount.

Generally, deductibles apply to property damage only, not the liability portion of auto-insurance policies or the liability portion of homeowners.

Coinsurance or co-pay

This amount is expressed as a fixed percentage that you’ll be required to pay once a deductible is satisfied. Coinsurance is similar to copayment provision. This is the flat fees you must pay for covered services or prescriptions.

With copayment, the risk is divided between the insurer and the insured. Though you have to bear the minimum amount of the claim as the insured, copayment reduces the burden of large premiums every month, something that can push you to your knees financially.

Coverage of medicines

Does the insurance plan cover the regular prescriptions? Every health insurance plan covers a particular set of medicines. If the medicine is not on the formulary and not covered. Thus as a patient, you have to go through a lengthy process to get coverage. The medicine list is also divided into tiers, which determines how much coinsurance you have to pay. List down your medicines, and compare that with what is covered, and that will tell you the out-of-pocket costs you may incur.

Choosing a health plan is not something you want to jump into; you have to take time and choose one that caters for all your needs.

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